Nonalcoholic fatty liver disease (NALFD) is a common condition where there is accumulation of excess fat in the liver of people who drink little or no alcohol. NAFLD can be divided into two categories. The most common form is not serious and is called fatty liver. In fatty liver, fat accumulates in the liver cells but causes no inflammation. The second form is nonalcoholic steatohepatitis (NASH) in which the fat accumulation in the liver is associated with liver cell inflammation and different degrees of scarring. NASH is a potentially serious condition that can progress to cirrhosis. Cirrhosis occurs when the liver cells are replaced by scar tissue resulting in the inability of the liver to work properly. Some individuals who develop cirrhosis may ultimately require a liver transplant.
The majority of individuals will have no symptoms. Obesity is thought to be the most common cause of NAFLD. In addition, individuals may have diabetes (high blood sugar), high blood pressure, and high cholesterol.
The diagnosis of NAFLD is usually suspected in an overweight person with mild elevations in liver blood tests or when increased fat infiltration of the liver is seen on ultrasound or CT scan (radiology studies). NAFLD can also occur with normal liver blood test. There are noninvasive radiology tests to screen for scar tissue in the liver. However, the most reliable way to determine the amount of scarring in the liver is by liver biopsy. In this procedure, a small needle is inserted through the skin into the liver after local anesthesia is given. A small piece of liver is obtained for microscopic examination. Liver biopsy rarely can be associated with serious risk including bleeding.
Treatments for NAFLD are currently limited. Some studies have shown that weight loss (10% of your body weight) can lead to regression of fat within the liver. Therefore, weight loss is recommended in individuals who are overweight with this condition. If present, controlling diabetes and treating elevated cholesterol are also important. There are currently studies underway evaluating medications to treat NASH.
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